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r. <br /> STL <br /> STL San Francisco <br /> Sample Receipt Checklist <br /> Submission #2004- 0 Cip Lo <br /> Checklist completed by (initials)�� Dated 3 10104 <br /> Courier nameSTL San Francisco ❑ Client <br /> Not / <br /> Custody seals intact on shipping container/samples Yes No Present <br /> Chain of custody present? YesNo <br /> Chain of custody signed when relinquished and received? Yes�No <br /> Chain of custody agrees with sample labels? Yes ,- No <br /> Samples in proper container/bottle? Yes_,-"No <br /> Sample containers intact? Yes_-No <br /> Sufficient sample volume for indicated test? Yes__LNo <br /> All samples received within holding time? Yeses/No <br /> Container/Temp Blank temperature in compliance (40 C±2)? Temp*1 °C Yes f o <br /> Ice Present Yes / No <br /> ter-VOA vials have zero headspace? No VOA vials submitted Yes--L.,/--No <br /> (if bubble is present, refer to approximate bubble size and itemize in comments as S (small -O), M (medium - O) or L(large f- O) <br /> Water- pH acceptable upon receipt? es ❑ No <br /> ❑ pH adjusted- Preservative used ❑ HNOs ❑ HCI ❑ H2SO4❑ NaOH ❑ ZnOAc-Lot#(s) <br /> For any item check-listed "No", provided detail of discrepancy in comment section below <br /> Comments <br /> Project Management [Routing for instruction of Indicated discrepancy(Ies)] <br /> Project Manager (initials) Date 1 104 <br /> Client contacted ❑ Yes ❑ No <br /> Summary of discussion <br /> Directive Action (per PM/Client) <br />